vestimИзвестия Национальной академии наук Беларуси. Серия медицинских наукProceedings of the National Academy of Sciences of Belarus, Medical series1814-60232524-2350The Republican Unitary Enterprise Publishing House "Belaruskaya Navuka"10.29235/1814-6023-2019-16-3-373-384vestim-516Research ArticleОБЗОРЫREVIEWSСовременные подходы к диагностике и лечению менингиом краниовертебральной областиModern approaches to the diagnosis and treatment of meningiomas of the craniocervical junction regionШанькоЮ. Г.ShankoY. G.

Шанько Юрий Георгиевич – д-р мед. наук, профессор, заместитель директора

Yuri G. Shanko – D. Sc. (Med.), Professor, Deputy Director

24, F. Skoriny Str., 220114, Minsk

yuri_shanko@hotmail.comСмеяновичА. Ф.SmeyanovichA. F.

Смеянович Арнольд Федорович – академик, д-р мед. наук, профессор, заведующий отделом

ул. Ф. Скорины, 24, 220114, г. Минск

Arnold F. Smeyanovich – Academician, D. Sc. (Med.), Professor, Head of the Department

24, F. Skoriny Str., 220114, Minsk

БулгакВ. В.BulgakV. V.

Булгак Владимир Вадимович – заведующий операционным блоком

Vladimir V. Bulgak – Head of the operating unit

vvbul-gak@gmail.comСычЕ. В.SychE. V.

Сыч Екатерина Викторовна – врач-нейрохирург

Ekaterina V. Sych – Neurosurgeon

ТанинА. Л.TaninA. L.

Танин Андрей Леонидович – канд. мед. наук, доцент

ул. П. Бровки, 3-3, 220013, г. Минск

Andrey L. Tanin – Ph. D. (Med.), Assistant Professor

ЧернышЕ. Ю.ChernyshE. Y.

Черныш Елена Юрьевна – науч. сотрудник

Elena Y. Chernysh – Researcher

laoris@ymail.comРеспубликанский научно-практический центр неврологии и нейрохирургииRepublican Research and Clinical Center of Neurology and Neurosurgery201916092019163373384Copyright © Шанько Ю.Г., Смеянович А.Ф., Булгак В.В., Сыч Е.В., Танин А.Л., Черныш Е.Ю., 20192019Шанько Ю.Г., Смеянович А.Ф., Булгак В.В., Сыч Е.В., Танин А.Л., Черныш Е.Ю.Shanko Y.G., Smeyanovich A.F., Bulgak V.V., Sych E.V., Tanin A.L., Chernysh E.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestimed.belnauka.by/jour/article/view/516

Проведен анализ 34 случаев менингиом краниовертебральной области, что составило около 1,6% от их общего числа у пациентов с первичными симптоматическими внутричерепными менингиомами. Боковая или переднебоковая локализация опухолей выявлена в 31 (91,2%) случае, задняя – в 2 (5,9%), передняя без латерализации – в 1 (2,9%). Из субокципитального доступа оперированы 27 (79,4%) пациентов, из заднебокового субокципитального (чрезмыщелкового) – 7 (20,6%). Тотально опухоли удалены в 24 (70,6%) случаях, субтотально – в 6 (17,6%), частично – в 4 (11,8%). Послеоперационной летальности не было. Рецидивирования опухолей в течение всего периода наблюдений не отмечено.

Субокципитальный латерализованный доступ с ляминэктомией до уровня нижнего полюса опухоли обеспечивал адекватное микрохирургическое удаление менингиом краниовертебральной области без резекции атлантоокципитального сочленения. Подход к матриксу новообразования осуществлялся после частичной резекции опухоли без тракции стволовых отделов мозга. Контроль стволовых функций на всех этапах удаления опухоли и вы деления позвоночной артерии обеспечивал интраоперационный нейромониторинг.

34 cases of craniocervical junction region meningiomas are analyzed. It was about 1.6% of the general number of patients with primary symptomatic intracranial meningiomas. Lateral or anterolateral meningiomas were in 31 cases (91.2%), posterior – in 2 cases (5.9%), anterior without lateralization – in 1 case (2.9%). 27 patients (79.4%) are operated on through the suboccipital approach, 7 patients (20.6%) – through the far-lateral suboccipital (transcondyllar) approach. Total removal of tumors was made in 24 cases (70.6%), subtotal removal – in 6 cases (17.6%), partial removal – in 4 cases (11.8%). Mortality was not observed. Intraoperative monitoring significantly improved the preservation of neurological functions. There were no cases of tumors recidivating during a long-term observation.

The suboccipital lateralized approach with laminectomy till the level of the lower pole of the tumor was sufficient to provide an adequate microsurgical removal of meningiomas of the craniocervical junction without resection of an atlantooccipital joint. The approach to the neoplasm matrix should be carried out after partial tumor resection without traction of brain stem parts. The use of intraoperative neuromonitoring supervised the stem functions at all stages of tumor removal and during the vertebral artery allocation.

краниовертебральная областьбольшое затылочное отверстиеменингиомымикрохирургияхирургические результатыcraniocervical junction region foramen occipitalis magnum meningiomas microsurgery surgical outcomesReferencesCBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2007–2011 / Q. T. Ostrom [et al.] // Neuro-Oncology. – 2014. – Vol. 16, Suppl. 4. – P. iv1–iv63. https://doi.org/10.1093/neuonc/nou223Ostrom Q. T., Gittleman H., Liao P., Rouse C., Chen Y., Dowling J., Wolinsky Y., Kruchko C., Barnholtz-Sloan J. CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2007– 2011. Neuro-Oncology, 2014, vol. 16, suppl. 4, pp. iv1–iv63. https://doi.org/10.1093/neuonc/nou223Davis, F. G. Centralized databases available for describing primary brain tumor incidence, survival, and treatment: Central Brain Tumor Registry of the United States; Surveillance, Epidemiology, and End Results; and National Cancer Data Base / F. G. Davis, B. J. McCarthy, M. S. Berger // Neuro-Oncology. – 1999. – Vol. 1, N 3. – P. 205–211. https://doi.org/10.1215/s1522851798000222Davis F. G., McCarthy B. J., Berger M. S. Centralized databases available for describing primary brain tumor incidence, survival, and treatment: Central Brain Tumor Registry of the United States; Surveillance, Epidemiology, and End Results; and National Cancer Data Base. Neuro-Oncology, 1999, vol. 1, no. 3, pp. 205–211. https://doi.org/10.1215/s1522851798000222Incidence and clinicopathological features of meningioma / M. Rohringer [et al.] // J. Neurosurg. – 1989. – Vol. 71, N 5. – P. 665–672. https://doi.org/10.3171/jns.1989.71.5.0665Rohringer M., Sutherland G. R., Louw D. F., Sima A. A. F. Incidence and clinicopathological features of meningioma. Journal of Neurosurgery, 1989, vol. 71, no. 5, pp. 665–670. https://doi.org/10.3171/jns.1989.71.5.0665Тиглиев Г. С. Внутричерепные менингиомы / Г. С. Тиглиев, А. Н. Кондратьев, В. Е. Олюшин. – СПб. : Изд-во РНХИ им. А. Л. Поленова, 2001. – 555 с.Tigliev G. S., Kondrat’ev A. N., Olyushin V. E. Intracranial meningiomas. St. Petersburg, Publishing house of the Russian Research Neurosurgical Institute named after A. L. Polenov, 2001. 555 p. (in Russian).George, B. Foramen magnum meningiomas: a review from personal experience of 37 cases and from a cooperative study of 106 cases / B. George, G. Lot // Neurosurg. Quarterly. – 1995. – Vol. 5, N 3. – P. 149–167. https://doi.org/10.1097/00013414-199509000-00001George B., Lot G. Foramen magnum meningiomas: A review from personal experience of 37 cases and from a cooperative study of 106 cases. Neurosurgery Quarterly, 1995, vol. 5, no. 3, pp. 149–167. https://doi.org/10.1097/00013414-199509000-00001Пуцилло, М. В. Нейрохирургическая анатомия. Атлас / М. В. Пуцилло, А. Г. Винокуров, А. И. Белов. – М. : Антидор, 2002–2007. – Т. 1. – 200 с.Putsillo M. V., Vinokurov A. G., Belov A. I. Neurosurgery anatomy. Atlas. Vol. 1. Мoscow, Antidor, 2002. 200 p. (in Russian).Boulton, M. R. Foramen magnum meningiomas: concepts, classifications, and nuances / M. R. Boulton, M. D. Cusimano // Neurosurg. Focus. – 2003. – Vol. 14, N 6. – P. 1–8. https://doi.org/10.3171/foc.2003.14.6.10Boulton M. R., Cusimano M. D. Foramen magnum meningiomas: concepts, classifications, and nuances. Neurosurgical Focus, 2003, vol. 14, no. 6, pp. 1–8. https://doi.org/10.3171/foc.2003.14.6.10Yaşargil, M. Meningiomas of basal posterior cranial fossa / M. Yaşargil, R. Mortara, M. Curcic // Advances and Technical Standards in Neurosurgery / ed. H. Krayenbühl. – Vienna, 1980. – P. 3–115.Yaşargil M., Mortara R., Curcic M. Meningiomas of basal posterior cranial fossa. Advances and Technical Standards in Neurosurgery. Vienna, 1980, pp. 3–115.Miller, E. Transoral transclival removal of anteriorly placed meningiomas at the foramen magnum / E. Miller, H. A. Crockard // Neurosurgery. – 1987. – Vol. 20, N 6. – P. 966–968. https://doi.org/10.1097/00006123-198706000-00026Miller E., Crockard H. A. Transoral transclival removal of anteriorly placed meningiomas at the foramen magnum. Neurosurgery, 1987, vol. 20, no. 6, pp. 966–968. https://doi.org/10.1097/00006123-198706000-00026Arnautović, K. I. Ventral foramen magnum meningiomas / K. I. Arnautović, O. Al-Mefty, M. Husain // J. Neurosurg. : Spine. – 2000. – Vol. 92, N 1. – P. 71–80. https://doi.org/10.3171/spi.2000.92.1.0071Arnautović K. I., Al-Mefty O., Husain M. Ventral foramen magnum meningiomas. Journal of Neurosurgery: Spine, 2000, vol. 92, no. 1, pp. 71–80. https://doi.org/10.3171/spi.2000.92.1.0071Color Atlas of Microneurosurgery / W. T. Koos [et al.]. – Stuttgart : Thieme Medical, 1985. – 420 p.Koos W. T., Spetzler R. F., Pendl G., Permeczky A., Lang J. Color Atlas of Microneurosurgery. Stuttgart, Thieme Medical, 1985. 420 p.Perneczky, A. The posterolateral approach to the foramen magnum // Surgery in and around the brain stem and the third ventricle / ed. M. Samii. – Berlin, 1986. – P. 460–466.Perneczky A. The posterolateral approach to the foramen magnum. Surgery in and around the brain stem and the third ventricle. Berlin, 1986, pp. 460–466.Babu, R. P. Extreme lateral transcondylar approach: technical improvements and lessons learned / R. P. Babu, L. N. Sekhar, D. C. Wright // J. Neurosurg. – 1994. – Vol. 81, N 1. – P. 49–59. https://doi.org/10.3171/jns.1994.81.1.0049Babu R. P., Sekhar L. N., Wright D. C. Extreme lateral transcondylar approach: technical improvements and lessons learned. Journal of Neurosurgery, 1994, vol. 81, no. 1, pp. 49–59. https://doi.org/10.3171/jns.1994.81.1.0049Foramen magnum meningiomas: experiences in 114 patients at a single institute over 15 years / Z. Wu [et al.] // Surg. Neurol. – 2009. – Vol. 72, N 4. – P. 376–382. https://doi.org/10.1016/j.surneu.2009.05.006Wu Z., Hao S., Zhang J., Zhang L., Jia G., Tang J., Xiao X., Wang L., Wang Z. Foramen magnum meningiomas: experiences in 114 patients at a single institute over 15 years. Surgical Neurology, 2009, vol. 72, no. 4, pp. 376–382. https://doi.org/10.1016/j.surneu.2009.05.006Таняшин, С. В. Методики и результаты хирургического лечения менингиом области большого затылочного отверстия / С. В. Таняшин, С. В. Кондрахов, В. Н. Шиманский // Рос. нейрохирург. журн. им. проф. А. Л. Поленова. – 2016. – T. 8, № 1. – C. 26–35.Tanyashin S. V., Kondrakhov S. V., Shimanskii V. N. Methods and results of surgical treatment of foramen magnusm meningiomas. Rossiiskii neirokhirurgicheskii zhurnal imeni professora A. L. Polenova [Russian neurosurgical journal named after professor A. L. Polenov], 2016, vol. 8, no. 1, pp. 26–35 (in Russian).Bruneau, M. Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisière Hospital and review of the literature / M. Bruneau, B. George // Neurosurg. Rev. – 2008. – Vol. 31, N 1. – P. 19–33. https://doi.org/10.1007/s10143-007-0097-1Bruneau M., George B. Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisière Hospital and review of the literature. Neurosurgical Review, 2008, vol. 31, no. 1, pp. 19–33. https://doi.org/10.1007/s10143-007-0097-1Pamir, M. N. Foramen magnum meningiomas [Electronic resource] / M. N. Pamir, K. Özduman. – Mode of access : http://clinicalgate.com/foramen-magnum-meningiomas/. – Date of access : 18.06.2019.Pamir M. N., Özduman K. Foramen magnum meningiomas. Available at: http://clinicalgate.com/foramen-magnum-meningiomas/ (accessed 18.06.2019).Bruneau, M. Classification system of foramen magnum meningiomas / M. Bruneau, B. George // J. Craniovertebr. Junction Spine. – 2010. – Vol. 1, N 1. – P. 10–17. https://doi.org/10.4103/0974-8237.65476Bruneau M., George B. Classification system of foramen magnum meningiomas. Journal of Craniovertebral Junction and Spine, 2010, vol. 1, no. 1, pp. 10–17. https://doi.org/10.4103/0974-8237.65476Intraoperative monitoring of foramen occipitalis magnum meningiomas surgery significantly improves the preservation of neurological functions / Y. Shanko [et al.] // Activitas Nervosa Superior Rediviva. – 2015. – Vol. 57, N 3. – P. 72–76.Shanko Y., Smeyanovich A., Bulgak V., Rodzich A. Intraoperative monitoring of foramen occipitalis magnum meningiomas surgery significantly improves the preservation of neurological functions. Activitas Nervosa Superior Rediviva, 2015, vol. 57, no. 3, pp. 72–76.Sohn, S. Conventional posterior approach without far lateral approach for ventral foramen magnum meningiomas / S. Sohn, C. K. Chung // J. Korean Neurosurg. Soc. – 2013. – Vol. 54, N 5. – P. 373–378. https://doi.org/10.3340/jkns.2013.54.5.373Sohn S., Chung C. K. Conventional Posterior approach without far lateral approach for ventral foramen magnum meningiomas. Journal of Korean Neurosurgical Society, 2013, vol. 54, no. 5, pp. 373–378. https://doi.org/10.3340/jkns.2013.54.5.373Surgical outcomes of craniocervial junction meningiomas: a series of 22 consecutive patients / M. Bydon [et al.] // Clinic. Neurol. Neurosurg. – 2014. – Vol. 117. – P. 71–79. https://doi.org/10.1016/j.clineuro.2013.11.023Bydon M., Ma T. M., Xu R., Weingart J., Olivi A., Gokaslan Z. L., Tamargo R. J., Brem H., Bydon A. Surgical outcomes of craniocervial junction meningiomas: a series of 22 consecutive patients. Clinical Neurology and Neurosurgery, 2014, vol. 117, pp. 71–79. https://doi.org/10.1016/j.clineuro.2013.11.023Microsurgical management of ventral and ventrolateral foramen magnum meningiomas / H. Bertalanffy [et al.] // Modern Neurosurgery of Meningiomas and Pituitary Adenomas. Acta Neurochirurgica / ed. : R. Fahlbusch [et al.]. – Vienna, 1996. – Vol. 65. – P. 82–85.Bertalanffy H., Gilsbach J. M., Mayfrank L., Klein H. M., Kawase T., Seeger W. Microsurgical management of ventral and ventrolateral foramen magnum meningiomas. Modern Neurosurgery of Meningiomas and Pituitary Adenomas. Acta Neurochirurgica. Vol. 65. Vienna, 1996, pp. 82–85.Crockard, H. A. The transoral approach for the management of intradural lesions at the craniovertebral junction: review of 7 cases / H. A. Crockard, C. N. Sen // Neurosurgery. – 1991. – Vol. 28, N 1. – P. 88–98. https://doi.org/10.1227/00006123-199101000-00014Crockard H. A., Sen C. N. The transoral approach for the management of intradural lesions at the craniovertebral junction: review of 7 cases. Neurosurgery, 1991, vol. 28, no. 1, pp. 88–98. https://doi.org/10.1227/00006123-199101000-00014Sen, C. N. An extreme lateral approach to intradural lesions of the cervical spine and foramen magnum / C. N. Sen, L. N. Sekhar // Neurosurgery. – 1990. – Vol. 27, N 2. – P. 197–204. https://doi.org/10.1227/00006123-199008000-00004Sen C. N., Sekhar L. N. An extreme lateral approach to intradural lesions of the cervical spine and foramen magnum. Neurosurgery, 1990, vol. 27, no. 2, pp. 197–204. https://doi.org/10.1227/00006123-199008000-00004Kratimenos, G. P. The far lateral approach for ventrally placed foramen magnum and upper cervical spine tumours / G. P. Kratimenos, H. A. Crockard // Br. J. Neurosurg. – 1993. – Vol. 7, N 2. – P. 129–140. https://doi.org/10.3109/02688699309103469Kratimenos G. P., Crockard H. A. The far lateral approach for ventrally placed foramen magnum and upper cervical spine tumours. British Journal of Neurosurgery, 1993, vol. 7, no. 2, pp. 129–140. https://doi.org/10.3109/02688699309103469Foramen magnum meningiomas: clinical outcome after microsurgical resection via a posterolateral suboccipital retrocondylar approach / H. Bassiouni [et al.] // Neurosurgery. – 2006. – Vol. 59, N 6. – P. 1177–1185. https://doi.org/10.1227/01.neu.0000245629.77968.37Bassiouni H., Ntoukas V., Asgari S., Sandalcioglu E. I., Stolke D., Seifert V. Foramen magnum meningiomas: clinical outcome after microsurgical resection via a posterolateral suboccipital retrocondylar approach. Neurosurgery, 2006, vol. 59, no. 6, pp. 1177–1185. https://doi.org/10.1227/01.neu.0000245629.77968.37Lower clivus and foramen magnum anterolateral meningiomas: surgical strategy / B. Pirotte [et al.] // Neurol. Res. – 1998. – Vol. 20, N 7. – P. 577–584. https://doi.org/10.1080/01616412.1998.11740567Pirotte B., David Ph., Noterman J., Brotchi J. Lower clivus and foramen magnum anterolateral meningiomas: surgical strategy. Neurological Research, 1998, vol. 20, no. 7, pp. 577–584. https://doi.org/10.1080/01616412.1998.11740567Midline and far lateral approaches to foramen magnum lesions / B. S. Sharma [et al.] // Neurol India. – 1999. – Vol. 47, N 4. – P. 268–271.Sharma B. S., Gupta S. K., Khosla V. K., Mathuriya S. N., Khandelwal N., Pathak A., Tewari M. K., Kak V. K. Midline and far lateral approaches to foramen magnum lesions. Neurology India, 1999, vol. 47, no. 4, pp. 268–271.Kandenwein, J. A. Foramen magnum meningiomas – experience with the posterior suboccipital approach / J. A. Kandenwein, H.-P. Richter, G. Antoniadis // Br. J. Neurosurg. – 2009. – Vol. 23, N 1. – P. 33–39. https://doi.org/10.1080/02688690802545932Kandenwein J. A., Richter H.-P., Antoniadis G. Foramen magnum meningiomas – experience with the posterior suboccipital approach. British Journal of Neurosurgery, 2009, vol. 23, no. 1, pp. 33–39. https://doi.org/10.1080/02688690802545932Meningiomas of the ventral foramen magnum and lower clivus: factors influencing surgical morbidity, the extent of tumour resection, and tumour recurrence / T. Kano [et al.] // Acta Neurochir. – 2010. – Vol. 152, N 1. – P. 79–86. https://doi.org/10.1007/s00701-009-0511-2Kano T., Kawase T., Horiguchi T., Yoshida K. Meningiomas of the ventral foramen magnum and lower clivus: factors influencing surgical morbidity, the extent of tumour resection, and tumour recurrence. Acta Neurochirurgica, 2010, vol. 152, no. 1, pp. 79–86. https://doi.org/10.1007/s00701-009-0511-2Surgical management of foramen magnum meningiomas / L. A. B. Borba [et al.] // Neurosurg Rev. – 2009. – Vol. 32, N 1. – P. 49–60. https://doi.org/10.1007/s10143-008-0161-5Borba L. A. B., de Oliveira J. G., Giudicissi-Filho M., Colli B. O. Surgical management of foramen magnum meningiomas. Neurosurgical Review, 2009, vol. 32, no. 1, pp. 49–60. https://doi.org/10.1007/s10143-008-0161-5Surgical management of foramen magnum meningiomas / S. N. Nair [et al.] // Neurosurg. Quarterly. – 2012. – Vol. 22, N 4. – P. 220–225. https://doi.org/10.1097/wnq.0b013e3182569227Nair S. N., Vikas V., Gopalakrishnan C. V., Menon G. Surgical management of foramen magnum meningiomas. Neurosurgery Quarterly, 2012, vol. 22, no. 4, pp. 220–225. https://doi.org/10.1097/wnq.0b013e3182569227Краниовертебральная патология / Д. К. Богородинский [и др.] ; под ред. Д. К. Богородинского, А. А. Скоромца. – М. : ГЭОТАР-Медиа, 2008. – 285 с.Borodinskii D. K., Skoromets A. A. (Ed.). Craniovertebral pathology. Мoscow, GEОТАR-Media Publ., 2008. 285 p. (in Russian).Meningiomas of the foramen magnum / B. M. Stein [et al.] // J. Neurosurg. – 1963. – Vol. 20, N 9. – P. 740–751. https://doi.org/10.3171/jns.1963.20.9.0740Stein B. M., Leeds N. E., Taveras J. M., Pool J. L. Meningiomas of the foramen magnum. Journal of Neurosurgery, 1963, vol. 20, no. 9, pp. 740–751. https://doi.org/10.3171/jns.1963.20.9.0740Arnautović, K. I. Ventral foramen magnum meningiomas / K. I. Arnautović, O. Al-Mefty, M. Husain // J. Neurosurg. : Spine. – 2000. – Vol. 92, N 1. – P. 71–80. https://doi.org/10.3171/spi.2000.92.1.0071Arnautović K. I., Al-Mefty O., Husain M. Ventral foramen magnum meningiomas. Journal of Neurosurgery: Spine, 2000, vol. 92, no. 1, pp. 71–80. https://doi.org/10.3171/spi.2000.92.1.0071Goel, A. Surgery on anterior foramen magnum meningiomas using a conventional posterior suboccipital approach: a report on an experience with 17 cases / A. Goel, K. Desai, D. Muzumdar // Neurosurgery. – 2001. – Vol. 49, N 1. – P. 102– 107. https://doi.org/10.1227/00006123-200107000-00016Goel A., Desai K., Muzumdar D. Surgery on anterior foramen magnum meningiomas using a conventional posterior suboccipital approach: a report on an experience with 17 cases. Neurosurgery, 2001, vol. 49, no. 1, pp. 102–107. https://doi.org/10.1227/00006123-200107000-00016Rhoton, A. L. The far-lateral approach and its transcondylar, supracondylar and paracondylar extensions / A. L. Rhoton // Neurosurgery. – 2000. – Vol. 47, Suppl. 3. – P. S195–S209. https://doi.org/10.1093/neurosurgery/47.3.s195Rhoton A. L. The far-lateral approach and its transcondylar, supracondylar and paracondylar extensions. Neurosurgery, 2000, vol. 47, suppl. 3, pp. S195–S209. https://doi.org/10.1093/neurosurgery/47.3.s195Variations of the extreme-lateral craniocervical approach: anatomical study and clinical analysis of 69 patients / E. Salas [et al.] // J. Neurosurg. : Spine. – 1999. – Vol. 90, N 1. – P. 206–219. https://doi.org/10.3171/spi.1999.90.2.0206Salas E., Sekhar L. N., Ziyal I. M., Caputy A. J., Wright D. C. Variations of the extreme-lateral craniocervical approach: anatomical study and clinical analysis of 69 patients. Journal of Neurosurgery: Spine, 1999, vol. 90, no. 1, pp. 206– 219. https://doi.org/10.3171/spi.1999.90.2.0206

The authors declare that there are no conflicts of interest present.